“Shaping” Healthcare Reform to Advance a Pro-Abortion Agenda
In its most recent annual report, the Planned Parenthood Federation of America boasts of the architectural role it played in the Affordable Care Act (ACA), also known as Obamacare: “Planned Parenthood worked…to help shape and pass the Affordable Care Act.”[i]
The “shape” the ACA took under Planned Parenthood’s guidance is one that benefits its bottom-line and advances its pro-abortion agenda.
Planned Parenthood ensured that the rules governing federal subsidies for insurance purchased through state-based insurance exchanges,[ii] and potentially other funds authorized by and appropriated through the ACA, would break from longstanding federal law and policy related to abortion funding.
“Planned Parenthood helped successfully defeat”[iii] efforts to bring the Stupak-Pitts amendment to a vote, an amendment that had passed with strong bipartisan support in the House of Representatives during the debate over an earlier healthcare reform bill.[iv] The Stupak-Pitts amendment would have made the abortion-funding restrictions of the ACA consistent with the Hyde Amendment, an annual appropriations rider since 1976 that prohibits federal funding appropriated through the Labor, Health and Human Services (LHHS) appropriations bill from being used for abortion or insurance plans that cover abortion.[v]
Instead, as a result of the efforts of Planned Parenthood, the ACA will allow federal dollars—paid directly from the Treasury to the insurance plan—to be applied to insurance plans that cover abortion.[vi] Further, without the Stupak-Pitts amendment the ACA lacks a comprehensive prohibition on the use of taxpayer dollars for abortions or insurance plans that cover abortions—an enormous loophole that could permit future public funding for abortions.
Currently, the ACA requires abortion-covering plans to employ an accounting separation for the federal subsidies it receives (an accounting separation that is not a permanent guarantee of the law[vii] and is one that Planned Parenthood vociferously objects to[viii]). But in doing so, the ACA creates a mandate on private dollars paying directly for abortion.
The ACA mandates that every person participating in the health insurance Exchanges (required by 2014 under the ACA) whose plan covers abortion must directly pay, at minimum, a $12-per-year premium that exclusively pays for abortions.
Many Americans will find it difficult to avoid this abortion premium mandate. On top of the fact that plans outside the Exchanges may be cost-prohibitive or provide substantially less benefits, the ACA has an abortion secrecy clause for plans within the Exchanges. The law, which Planned Parenthood proudly shaped, permits insurance plans within the Exchanges that cover abortions to inform enrollees of this coverage only at the time of enrollment and, even then, only in the summary of benefits. The abortion premium mandate is covert: you cannot know whether a particular plan covers abortion until the time you sign up.
Planned Parenthood had a clear hand in molding another anti-life, anti-conscience provision of the ACA that is already impacting private health insurance plans and eliminating life-affirming choices from the market.
Often referred to as “the HHS mandate,” the Obama Administration’s implementation of the ACA’s “preventive services” provision requires that nearly all private health insurance plans fully cover, without co-pay, all drugs and devices labeled by the Food and Drug Administration (FDA) as “contraception.” The FDA’s definition of “contraception” is broad and includes drugs and devices with known life-ending mechanisms of action, including the abortion-inducing drug ella.[ix]
The Obama Administration’s decision to mandate coverage for ella and other life-ending drugs was demonstrably influenced by Planned Parenthood.
To determine what drugs, devices, and services would be included in the ACA’s preventive services mandate, the U.S. Department of Health and Human Services (HHS) relied on an ostensibly “evidence based” recommendation from the “independent” Institute of Medicine (IOM). Although “independent” from HHS, several members of the Institute of Medicine (IOM) panel have direct ties to Planned Parenthood[x] as well as other openly pro-abortion organizations.[xi] The list of organizations invited to present at the IOM’s three public meetings on the mandate underscores its abortion advocacy bias.[xii]
Notably, at the first meeting, groups invited to speak on “women’s issues” included Planned Parenthood.[xiii] As a distributor of “contraceptives,” Planned Parenthood stands to gain tremendously from a requirement that insurance plan cover contraceptives without co-pay, a financial stake which was never disclosed as a conflict of interest.
The second meeting included a presentation by a former official affiliate of Planned Parenthood,[xiv] the Guttmacher Institute.[xv] Planned Parenthood’s former official research arm likewise suggested that the IOM recommend the “full range” of FDA-approved “contraceptives,” including the abortion-inducing drug ella, be part of the insurance coverage that nearly all Americans must purchase.
In July 2011, Dr. Linda Rosenstock (the IOM panel’s committee chair) explained, unequivocally, that the drug ella was included in her committee’s recommendation. Though Dr. Rosenstock stated her committee considered “every” comment that was made before them, the IOM report utterly failed to address the serious concerns repeatedly presented during the public comments period of its meetings by pro-life groups, including AUL.[xvi] Nowhere in its 250-page report did the committee even mention ella’s life-ending mechanisms of action.
Also absent from the 250-page report was any mention that other FDA-labeled “contraceptives,” including Plan B and Intrauterine Devices (IUDs), can work by preventing the implantation of an already developing human embryo – another fact presented at every meeting, a fact that the FDA notes in its labeling of the drugs, and a fact that HHS has included in its information on “birth control” methods.
The IOM Report acknowledged that the panel may have even considered abortion as a “preventive service” had it not felt otherwise constrained by the ACA: “Finally, despite the potential health and well-being benefits to some women, abortion services were considered to be outside of the project’s scope, given the restrictions contained in the [ACA].”[xvii] Thus, the Planned Parenthood-influenced panel noted that, in its view, ending human life could be considered disease prevention.
Dissenting from the IOM recommendation, committee member Dr. Anthony Lo Sasso criticized the committee’s lack of transparency and creation of an advocacy-based recommendation:
The committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee’s composition. Troublingly, the process tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy.[xviii]
Naturally, Planned Parenthood “hailed the Institute of Medicine (IOM)’s recommendation”[xix] The recommendation was, after all, filtered through Planned Parenthood’s “lens of advocacy”—a lens so distorted, it would equate destruction of human life with disease prevention.
Rejoicing over the mandate—which will eliminate plans that do not cover the abortion-inducing drug ella from the health insurance market—Dr. Vanessa Cullins, Vice President for Medical Affairs at Planned Parenthood Federation of America, applauded “covering birth control without co-pays” as “one of the most important steps” towards “keep[ing] women and children healthy.”[xx] Dr. Cullins’ health advice also includes telling women to simply accept contracting sexually transmitted diseases (STDs) as an unavoidable part of life: “In terms of sexually transmitted diseases, expect to have HPV once you become sexually intimate, all of us get it.”[xxi] It seems that Planned Parenthood’s benchmark for “healthy” women is “not pregnant” women.
With Planned Parenthood’s help, President Obama’s 2008 campaign promise to put abortion at “the heart” of his healthcare plan[xxii] has come to fruition. Planned Parenthood continues to work to ensure the Obama Administration keeps its promise.
[i] See Planned Parenthood Fed’n of Am. Inc., Annual Report 2009-2010 (2011), available at http://issuu.com/actionfund/docs/ppfa_financials_2010_122711_web_vf?mode=window&viewMode=doublePage (last visited Sept. 21, 2012).
[ii] The ACA requires that by 2014 state-based Exchanges be established for the purchase of private health insurance. The federal government will provide premium subsidies for those who do not qualify for Medicaid but whose household income is up to 400% of the federal poverty level.
[iii] See Planned Parenthood: House Push to Repeal Health Care Law Would Hurt Women’s Health, Planned Parenthood, Jan. 14, 2011, available at http://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-house-push-repeal-health-care-law-would-hurt-womens-health-35797.htm (last visited Sept. 21, 2012).
[v] The text of the Hyde Amendment states that “None of the funds…shall be expended for any abortion,” §507(b), and that “None of the funds … shall be expended for health benefits coverage that includes coverage of abortion.” §507(c).
[vi] The ACA does permit states to “opt-out” of allowing insurance plans in their state Exchange from covering abortion. To do so, a state must enact a separate piece of legislation. To date, 18 states have passed “opt-out” laws, protecting their citizens against the covert abortion premium mandate.
[vii] The restriction lapses if Congress does not renew the Hyde Amendment, a vulnerable rider to an appropriations bill. Pub. L. 111-148 (2010) §1303(b)(1)(B). The abortion lobby is actively campaigning for the removal of the Hyde Amendment. For example, the National Organization of Women (NOW) has vowed, “[T]he Board of NOW is hereby instructed to develop a long-term strategy with other allied organizations for the defeat of the Hyde Amendment and that the grassroots level of NOW be urged to take action in an aggressive campaign to repeal the Hyde Amendment…” 2010 NOW Conference Resolutions, Hyde and Seek-Repeal of the Hyde Amendment, National Organization for Women, http://www.now.org/organization/conference/resolutions/2010.html#Hyde (last visited Oct. 17, 2012).
[viii]See Planned Parenthood: House Push to Repeal Health Care Law Would Hurt Women’s Health, Planned Parenthood, Jan. 14, 2011, available at http://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-house-push-repeal-health-care-law-would-hurt-womens-health-35797.htm (last visited Sept. 21, 2012). ( “Planned Parenthood continues to oppose the unacceptable abortion provisions in the new health care law, which sets up a complicated system requiring two separate insurance payments from individuals, one for abortion coverage and one for all other health care coverage.”)
[ix] See The Con: Life-Ending Drugs & Devices, Americans United for Life, http://www.aul.org/the-con-life-ending-drugs-devices/ (last visited Sept. 21, 2012).
[x] According to her biography, Dr. Paula Johnson “served for many years on the board of Planned Parenthood League of Massachusetts and chaired the board from 1997-1998,” see http://www.bphc.org/boardofhealth/boardmembers/Pages/Home.aspx (last visited Sept. 21, 2012); Dr. Magda Peck served as chair and vice-chair of the Board of Directors Planned Parenthood of Nebraska Council Bluffs (now Planned Parenthood of the Heartland) from 2006-2009, see http://www4.uwm.edu/secu/news_events/sph-dean/Peck-cv.pdf (last visited Sept. 21, 2012); Dr. Carol Weisman served as a member of the Affiliate Medical Committee of Planned Parenthood of Maryland from 1993-1997 and was a member of the Board of Directors of Planned Parenthood of Maryland from 1978-1984, see http://www.pennstatehershey.org/c/document_library/get_file?folderId=229089&name=DLFE-25907.pdf (last visited Sept. 21, 2012).
[xi] Dr. Francisco Garcia has worked with the International Planned Parenthood Federation, see http://orwh.od.nih.gov/about/Garcia%20(updated%202-18-10)–edited%20clean%20copy.pdf (last visited Sept. 21, 2012). Dr. Paula Johnson serves on the board of the Center for Reproductive Rights, an organization which seeks to expand abortion access, see http://www.bphc.org/boardofhealth/boardmembers/Pages/Home.aspx (last visited Sept. 21, 2012). Dr. Claire Brindis is a co-founder of the Bixby Center for Global and Reproductive Health. The Bixby Center provides abortion training and runs initiatives designed to increase and expand abortion services,see http://bixbycenter.ucsf.edu/research/abortion.html (last visited Sept. 21, 2012). Dr. Brindis also chaired the Population, Family Planning and Reproductive Health Section (PRSH) of the American Public Health Association. The PRSH has a “task force” dedicated to abortion, see http://www.apha.org/membergroups/sections/aphasections/population/benefits/taskforces.htm (last visited Sept. 21, 2012). Dr. Angela Diaz has served as a Board Member for the Physicians for Reproductive Choice and Health, see http://www.prch.org/about-board-directors (last visited Sept. 21, 2012). Dr. Alina Salganicoff has worked as a trainer and counselor for CHOICE, “a Philadelphia-based reproductive health care advocacy organization,” see http://www.kff.org/womenshealth/upload/Speaker-Biographies-Women-and-Health-Care-A-National-Profile.pdf (last visited Sept. 21, 2012).
[xii]The IOM meeting information and agendas are available at http://iom.edu/Activities/Women/PreventiveServicesWomen.aspx (last visited Sept. 21, 2012).
[xiii] Other invited presenters included the National Women’s Law Center which states on its website, “We’re working to ensure that women have access to abortion care by protecting and advancing this fundamental right.” National Women’s Law Center, Our Issues, Abortion, available at http://www.nwlc.org/our-issues/health-care-%2526-reproductive-rights/abortion (last visited Sept. 21, 2012).
[xiv] President Sharon Camp has described the relationship between Planned Parenthood and Guttmacher as “the divorce that didn’t work.” See Too Many Aborted, You’ve Been Guttmacher’d!, YouTube (Sept. 6, 2011), available at http://www.youtube.com/watch?v=FYXwurVh0Bs&feature=player_embedded (last visited Sept. 21, 2012).
[xv] The Guttmacher Institute’s “Guiding Principles” include working to “protect, expand and equalize access to information, services and rights that will enable women and men to … exercise the right to choose abortion.”Guttmacher Institute, “Mission,” available at http://www.guttmacher.org/about/mission.html (last visited Sept. 21, 2012).
[xvi] Never formally invited by the IOM to present, pro-life organizations including AUL attended and, during the public comments portion of every open IOM committee meeting, urged the panel against including life-ending drugs and devices in a mandate that would apply to nearly all health insurance plans. The IOM panel was reminded by AUL and others that the “preventive services” provision was, as its author Senator Barbara Mikulski (D-MD) stated, “strictly concerned” with “preventing diseases.” See Cong. Rec. S12274 (daily ed. Dec. 3, 2009) (colloquy between Sen. Mikulski and Sen. Casey), available at http://thomas.loc.gov. The IOM panel was also reminded that Senator Mikulski made assurances that abortion would not be covered “in any way.” Id. Further, at every meeting, it was explained to the IOM panel that ella, newly approved by the FDA as a so-called “emergency contraceptive,” can end even an “established” pregnancy. See D. Harrison & J.Mitroka, Defining Reality: The Potential Role of Pharmacists in Assessing the Impact of Progesterone Receptor Modulators and Misoprostol in Reproductive Health, 45 Annals Pharmacotherapy 115 (Jan. 2011).
[xvii] Clinical Preventive Services for Women: Closing the Gaps, Institute of Medicine (July 19, 2011) at 21.
[xviii] Committee on Preventive Services for Women; Institute of Medicine, Clinical Preventive Services for Women: Closing the Gaps 207 (2011) available at http://www.nap.edu/catalog.php?record_id=13181 (last visited Sept. 21, 2012).
[xix] Planned Parenthood Hails Institute of Medicine Recommendation on Coverage of Prescription Birth Control Without Co-Pays, Planned Parenthood, July 19, 2011, available at http://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-hails-institute-medicine-recommendation-coverage-prescription-birth-control-37374.htm (last visited Sept. 21, 2012).
[xxi] See Planned Parenthood, Let’s Talk About Sex – Sexual health advice from Dr. Vanessa Cullins, YouTube (Oct. 20, 2009), available at http://www.youtube.com/watch?v=wvlCx3w_tss (last visited Sept. 12, 2012).
[xxii] At a Planned Parenthood Action Fund event in July 2007, then-candidate Obama stated, “In my mind, reproductive care is essential care, basic care, so it is at the center, the heart of the [health care] plan that I [will] propose.” Laura Escheverria, Barack Obama Before Planned Parenthood Action Fund (transcription), available at https://sites.google.com/site/lauraetch/barackobamabeforeplannedparenthoodaction (last visited Sept. 21, 2010).
The next day, the Chicago Tribune reported that an Obama spokesman confirmed that “reproductive health services” included abortion. Mike Dorning, Democrats Pledge Support for Wide Access to Abortion, Chicago Tribune, Jul. 18, 2007, available at http://articles.chicagotribune.com/2007-07-18/news/0707180134_1_abortion-rights-opponents-call-partial-birth-abortion-planned-parenthood-action-fund (last visited Sept. 21, 2012).